Correct a Deviated Septum with Plastic Surgery | Leonard Grossman, M.D. Previous Next Correct a Deviated Septum with Plastic Surgery Few people are born with the perfect nose. Most of us have a bone to pick with our noses, especially if we’ve suffered an injury that has resulted in deformity. Rhinoplasty , once of the most popular plastic surgery procedures in the nation, has helped millions of people – both women and men – who have suffered from crooked, overly long or overly wide noses. The treatment creates symmetry with a patient’s facial features by reducing the length and width of the nose or altering its shape altogether. But while many are aware of the cosmetic benefits of the procedure, not everyone knows about the medical benefits. Rhinoplasty surgery can also assist individuals suffering from a deviated septum. The septum is name given to the bone and cartilage between the two nostrils that separates the nasal cavity. Usually, the septum lies in the center of the nose, ensuring the individual’s nasal passages are also symmetrical. A deviated septum , one of the most common physiological disorders of the nose, refers to a displacement causing the bone and cartilage to lean toward the left or right side.

The displacement can be caused by an injury to the nose but can also be the result of a congenital disorder resulting from compression of the nose during child birth. Regardless of what caused the issue, a deviated septum can pose serious problems for those who suffer from it. A deviated septum can lead to a number of symptoms that can entirely disrupt an individual’s life. When the deviation is severe, the range of symptoms consequently increases, often resulting in unbearable pain for the individual. The most common symptoms include: Frequent sinus infections Getting Help for a Broken Nose Getting Help for a Broken Nose January 31, 2014 Your nose occupies a prominent position in the middle of your face, unprotected and exposed. That makes it especially vulnerable to impact and susceptible to damage. You’ll never see it coming. A car accident, a collision on the basketball court, or a misplaced elbow on a crowded bus, and suddenly you’ve suffered a nasal fracture, or as it’s more commonly known, a broken nose. What Is a Broken Nose? The term “broken nose” is slightly misleading. A nasal fracture can be a complete break in the nasal bones, or it may only be a crack.

In both breaks and cracks, there is generally also damage to the surrounding nasal cartilage.Especially likely to be impacted is the nasal septum, a flexible partition that separates the left and right sides of the nose. How Do I Know My Nose Is Broken? This is an excellent and very important question. Immediate symptoms of a broken nose include: Pain Clear fluid draining from your nose Blockage of one or both nostrils Bruising, swelling and tenderness around the nose As time passes, a broken nose may cause: A bruise-like discoloration under the eyes A deviated septum A twisted or crooked nose Chronic nasal obstruction What the Nose Knows that You Don’t Here’s a problem, though. The symptoms of a mild nasal fracture are often limited to a brief nosebleed and/or mild swelling. For this reason, many people do not realise they have broken their nose and do not seek medical treatment. Without treatment, people with nasal fractures can develop problems breathing and sleeping. A nasal fracture that heals without treatment may even cause deformity and facial imbalance. This is why it’s very important to consult with your doctor immediately after any injury to your face.

In a best-case scenario, I try to treat an injured nose within three to six hours from the time of injury. 3 Reasons to Treat Broken Noses with “Closed Reduction” During the golden window within six hours of the time of injury, significant swelling has not yet occurred. This allows me to treat the nose with an immediate closed reduction. A closed reduction is the medical term for resetting the broken bone without actually opening up the nose surgically. Closed reduction surgery is a desirable treatment option because Setting the bone can be done with a local anaesthetic There will be no incision resulting from the procedure A closed reduction procedure does not leave scars What Happens During a Closed Reduction for a Broken Nose? I encourage patients to begin using a saline nasal spray twenty-four hours before their procedure until about one week after surgery. Saline promotes healing, removes old blood, and helps move mucus out of the nose During a closed reduction procedure, I use a nasal speculum to open my patient’s nostrils. Then I use a special instrument to help me realign broken bones and cartilage and return them to their original positions. Pain following closed reduction of a nasal fracture is generally mild and can be treated with over-the-counter analgesics.

It is likely to subside in the first few days after the treatment. There will also be swelling and bruising. Can We Answer Your Questions? If you’d like more information about treating a broken nose or you would like to schedule an appointment, please contact our offices on 1300 555 095 . You can also use email or the ‘book consultation’ feature of this website to make an appointment. Be sure to come back soon to read my next blog. In it, I’ll talk about treatments that can take a broken nose from “immediately repaired” to “beautifully restored.” Ask Dr Marcells a question marked fields are required You can ask a question by completing the form below. If you have any questions, call us on 1300 555 095 , or email us: info@af.com.au Name* What is a Septal Perforation? What is a Septal Perforation? Septal Perforation Links Septal Perforation Facts A septal perforation, also referred to as a perforated septum, is a “hole” in the nasal septum and is considered a very complex problem.

The nasal septum is the tissue that separates the nose into two distinct sides. The nasal septum is a partition in the nasal cavity, which allows proper flow of air through the nasal passageways. If the septum is perforated, the airflow can be turbulent or obstructed causing difficulty breathing, crusting, and other symptoms. It’s important to note that the perforation is located in the cartilaginous and/or bony portion of the septum. It is not just a single-layered hole—hence the complexity of the condition. It is actually a three-layered “through and through” hole, which makes correction of the problem tricky. The perforation violates all three tissue layers, including the right and left mucoperichondrium and the intervening septal cartilage or bone. This cross section of a nose shows the 3 distinct layers that must be closed to repair the perforated septum. The nasal septum is the partition that separates the nose into two sides. Causes of Septal Perforation A hole or perforation of your nasal septum can occur as an unwanted result of previous nasal surgery, a chemical insult to the membranes, or from a nasal fracture or other nose injury.

The long term use of certain steroid or other nose sprays has even been linked to this problem. The septum and its covering layers are delicate and can be easily injured. Common Causes The most common causes for septal perforations to occur are listed below: Previous nasal surgery procedures: Unfortunately, many perforations occur after septoplasty and rhinoplasty operations. Also, damage to the septum can follow sinus surgery and from cauterizing of the septum for nose bleeds. These cases are quite challenging when most of the normal septal cartilage has been removed. Cocaine Use: Even a one-time use of cocaine in the nose can cause a hole in the septum. Street cocaine is rarely pure and is often cut with abrasive and irritating substances, such as talc or borax, which, when combined with the cocaine eats right through the septal membrane and cartilage. Cocaine itself has extreme vasoconstrictive effects causing decreased blood supply. Chronic cocaine use is worse and can totally destroy the inside of the nose, leading to infections, extreme scarring and total nasal collapse. In the case of complete destruction of the septum and nasal collapse, these cases may not be repairable.

Trauma: A new or previous nasal fracture due to an accident or sports injury can cause a perforation. Often, these perforations may go unnoticed until symptoms occur and the hole has enlarged. Infection: Perforations that are initially small can enlarge due to continued inflammation or infections. Prolonged use of nasal steroids or decongestants: Some steroid nasal sprays can be very irritating to the septal mucosa when used on a long-term basis and can lead to perforation. Excessive, long term nose picking Autoimmune conditions: Some systemic diseases can predispose to septal perforation including, renal disease, vasculitides, and collagen vascular disorders, such as lupus, rheumatoid arthritis, and polychondritis. Symptoms of a Perforated Septum When a septal perforation is present, a patient can have any number of uncomfortable and irritating symptoms that make daily life more challenging. This can be represented by one, or a combination, of the symptoms listed below that can be extremely time consuming, annoying and in some cases, so debilitating that it necessitates lifestyle changes.

Common Symptoms Nasal crusting: When the edges of the hole are open, crusts form and enlarge as one breathes, requiring daily nasal irrigations and frequent visits to the doctor remove crusting. Sometime the crusts will cause a foul odor that others around can easily discern. When crusts fill the nose, the patient’s sense of smell is decreased as well. Nasal bleeding: The raw edges of the perforation can bleed spontaneously at the most unwanted times. If frequent enough, blood loss may be significant. Bleeding, when it stops, forms scabs and crusts which then clog the nasal airway. Whistling: When the perforation is small the airflow through the nose can cause a whistling sound, which can be quite embarrassing and constant. Breathing difficulty: Sometimes a larger perforation disrupts the normal nasal cycle and airflow giving patients a feeling that their noses aren’t working well. Usually when the septal wall is repaired normal breathing returns as long as the internal scarring has not been excessive. Runny Nose: Rhinorrhea is the medical term that describes a nose that runs. When you have a perforated septum, the abnormal airflow can dry out the internal membranes.

Your nose responds by generating secretions to try to keep it moist and so the nose drips or runs. Recommended Treatment Surgical treatment, known as septal perforation repair, is indicated if symptoms are chronic and effect the patient’s quality of life. Surgery is also recommended if the patient has not responded well to nonsurgical treatments. If a patient has a septal perforation but no symptoms, surgical repair may not be necessary. Some patients, with holes in their septum that are posteriorly located deep in the nose do not even know they have a perforation, don’t need to do anything. But, as the perforation enlarges or if the perforation is located closer to the front of the nose, symptoms increase and become more bothersome. When the patient has not responded well to non-surgical approaches, surgery is often indicated. Dr. Kridel believes patients do much better long-term with permanent repairs with surgery rather than constant irrigations or septal buttons, because a surgical solution is more apt to return normal nasal function and be hassle-free. Correct a Deviated Septum with Plastic Surgery | Leonard Grossman, M.D. Previous Next Correct a Deviated Septum with Plastic Surgery Few people are born with the perfect nose.

Most of us have a bone to pick with our noses, especially if we’ve suffered an injury that has resulted in deformity. Rhinoplasty , once of the most popular plastic surgery procedures in the nation, has helped millions of people – both women and men – who have suffered from crooked, overly long or overly wide noses. The treatment creates symmetry with a patient’s facial features by reducing the length and width of the nose or altering its shape altogether. But while many are aware of the cosmetic benefits of the procedure, not everyone knows about the medical benefits. Rhinoplasty surgery can also assist individuals suffering from a deviated septum. The septum is name given to the bone and cartilage between the two nostrils that separates the nasal cavity. Usually, the septum lies in the center of the nose, ensuring the individual’s nasal passages are also symmetrical. A deviated septum , one of the most common physiological disorders of the nose, refers to a displacement causing the bone and cartilage to lean toward the left or right side. The displacement can be caused by an injury to the nose but can also be the result of a congenital disorder resulting from compression of the nose during child birth.

Regardless of what caused the issue, a deviated septum can pose serious problems for those who suffer from it. A deviated septum can lead to a number of symptoms that can entirely disrupt an individual’s life. When the deviation is severe, the range of symptoms consequently increases, often resulting in unbearable pain for the individual. The most common symptoms include: Frequent sinus infections Nasal Anatomy Nasal Anatomy Justin H. Turner, M.D., Ph.D. Devyani Lal, MD Jayakar V. Nayak, MD, PhD anatomy The nose is the organ of smell, and serves in breathing and airway function. The nasal cavity lies between the base of the brain (skull base) and above the oral cavity and palate below. The nasal cavity is surrounded by paired, air-filled chambers on each side, and these lie towards the sides and above the nose (the “paranasal sinuses”). These paired sinuses are the maxillary (lying in the cheek bones), frontal (lying between the eyebrows), ethmoid (between the eyes) and the sphenoid sinuses (between the center of the skull base and the nose).

The paranasal sinuses drain into the nose, and their detailed anatomy is discussed in another Patient Education section. Smell is perceived through part of the roof of the nasal cavity (olfactory cleft) that is just next to the part of the brain responsible for smell (olfactory bulb and fossa). This bony partition in this area (“cribriform” bone) is pierced by numerous nerves (“Olfactory” nerves) on each side. These nerves supply the top parts pf the nasal septum, middle and inferior turbinates and carry smell sensations to the brain. In the nasal cavity, physical obstruction and injury, or inflammation to the olfactory cleft by tumors, polyps etc. can affect smell. The nasal cavity is divided by a vertical partition (the “nasal septum”) into a right and left side. The nasal septum is made up of cartilage (quadrangular cartilage) towards the front of the nose, and bone towards the back. Parts of four different bones make up the bony septum: the perpendicular plate of the ethmoid bone, vomer, and the nasal crest of the maxilla and palatine bones.

The nasal septum is often not located in the midline, but pushed over to the right or left side in various parts. This shift is referred to as a “deviated nasal septum”. These deflections usually occur where the various parts of the nasal septum join together, due to overgrowth of one or more components. Sometimes, trauma to the nose can also create deflections and fractures. When this deviation is large or severe it can result in narrowing of one or both sides of the nasal cavity. In the front, the left and right sides of the nasal cavities form the right and left nares. Towards the back, these nasal passageways terminate into the right and left “choana” and open into a common chamber called the “nasopharynx”. The nasopharynx is the upper part of the throat (pharynx), which lies below the skull base and opens into the oropharynx, the part of the throat that lies behind the mouth. When we breathe in, air travels through the nostril, through the right and left nasal passages, through the choana into the nasopharynx, then the oropharynx, and then through the voice box (larynx) into the lungs.

The nasopharynx contains a collection of lymphoid tissue towards the midline, called the adenoids. Into each side of the nasopharynx open the eustachian tubes. The eustachian tubes connect the nasopharynx to the middle ear (the part of the ear cavity behind the ear drums). The eustachian tubes help air to pass from the ear to the nasopharynx and vice versa and thus help fill the middle ear with air and equalize air pressure with the atmosphere. This function is very important for hearing normally. When the adenoids are enlarged or infected, eustachian tube, and thus ear function can be affected, leading to problems with fluid in the ear, or ear pain and pressure. Enlarged adenoids can also block the choana and affect breathing through the nasal passageways, leading to mouth-breathing and snoring. The nasal cavity is bounded in by bony sidewalls (lateral nasal walls). Attached to these sidewalls are three structures called turbinates. The turbinates are fingerlike projections made up of a bony core and outer soft tissue.

They are covered with a lining (mucosa) which is continuous with the lining of the rest of the nasal cavity. The turbinates serve to increase the mucosal surface area of the nasal cavity, and also direct smooth nasal airflow towards the lungs. Between each turbinate and nasal sidewall lies a space termed a meatus. These spaces are named according to the turbinate above them. The bottom most turbinate, the “inferior” turbinate serves the most important role in the air-conditioning action of the nose. This capacity of the inferior turbinate comes from soft tissue below the lining. This tissue is extremely rich in blood vessels and glands, and helps the nasal air-conditioning function. The inferior turbinate is the largest of the three paired turbinates, and runs along the entire length of the lateral nasal wall, adjacent to the nasal floor. Sometimes, the inferior turbinate can get enlarged due to allergy or irritation, and can cause nasal blockage and a runny nose. The tear duct (nasolacrimal duct), which drains tears from the eye, drains beneath the inferior turbinate into the inferior meatus.

The middle turbinate lies above the inferior turbinate and is a very important structure with a complex, boomerang shape. The front part of the middle turbinate is vertical, attaching to the skull base. The back of the middle turbinate is horizontal, and attaches to the nasal sidewall just above the inferior turbinate. The middle part of the middle turbinate is oblique, connecting the vertical and horizontal parts, and is thus connected both the skull base in the front and the nasal sidewall in the back. The frontal sinus and anterior ethmoid sinus cells drain beneath the middle turbinate into the middle meatus. The superior turbinate is the smallest of the turbinates. It resides just above and behind the middle turbinate. The sphenoid sinus and posterior ethmoid sinus cells drain into an area between the nasal septum and superior turbinate called the sphenoethmoid recess. physiology The nose is the first passageway through which we deliver air to our lungs. As we breathe, the nose provides “resistance” and this resistance helps generate negative pressure by which inhaled air can reach the lungs.

The nose is also the air-conditioner of our breathing passageways: it helps filter, humidify, warm or cool the air we inhale such that the air delivered to our lungs is of the best possible quality. The entire nasal cavity is covered with a special lining (“mucosa”). This mucosal surface has microscopic hair like structures (cilia) and many mucus producing glands. The moist, mucus-covered surface (mucus blanket) of the nasal cavity traps harmful particles such as allergens or bacteria. This mucus blanket is continuously propelled backwards by millions of cilia that all beat to the same rhythm such that the trapped particles are directed to the back of the nasal cavity. The sidewall of the nose also contains structures that are rich in blood vessels and glands called turbinates; these humidify and warm or cool the inhaled air. Each side of the nose takes turns to work (the “nasal cycle”) such that while one side works, the other rests. The nose thus cycles function to each side every 90 minutes to 4 hours.

(You can read more in a separate Patient Education topic on Nasal Physiology .) blood supply The nasal cavity has a very rich blood supply arising from both the internal and external carotid arteries. A confluence of these blood vessels supplying the nasal septum in the front (“Kiesselbach plexus” in the “Little’s area”) is a common source of nasal bleeding (epistaxis). This area can often be cauterized in the office to stop nasal bleeding. The anterior and posterior ethmoid arteries, both branches of the internal carotid artery system supply the upper nasal septum and nasal sidewalls. The superior labial branch of the facial artery supplies the front part of the nose. The sphenopalatine artery, a branch of the external carotid system supplies most of the back of the nasal cavity. It enters the nasal cavity through an opening located along the nasal sidewall called the sphenopalatine foramen. When nasal bleeding is more from the back part (posterior epistaxis), this artery is often the culprit. When recurrent posterior epistaxis becomes a problem, the sphenopalatine artery may need to be tied or embolized.

In addition to this larger vasculature, there is a confluence of the small vessels that supplythe front portion of the nasal septum that is termed Kiesselbach’s plexus. This lattice of veins is a common source of nasal bleeding (epistaxis) due to trauma and dry air exposure, and may require medical attention in many cases. Nerve Supply Sensation to the nose is provided to the nasal cavity primarily via branches of the trigeminal nerve. The ophthalmic division (V1) of the trigeminal nerve gives off the anterior and posterior ethmoidal nerves, which supply sensation to the top half of the nasal cavity and septum. The maxillary division (V2) of the trigeminal nerve exits the skull base via an opening called the foramen rotundum and ultimately divides into several smaller branches. The largest of these branches is the sphenopalatine nerve, which travels with the corresponding artery and supplies sensation to the lateral nasal wall and septum. Sensations of the nasal cavity can be disrupted by injury to the mid-face and palate due to trauma, tumors or surgery, resulting in numbness. The nose is also richly supplied by special nerves from the autonomic nervous system.

The autonomic nervous system controls many involuntary functions in the body (blood pressure, heart rate, breathing) via “sympathetic” and “parasympathetic” nerve fibers. In the nose, the autonomic nerves control the air-conditioning action, nasal resistance, mucus secretion and the function of the cilia and mucus blanket. Nasal secretions and mucus gland production are controlled by “parasympathetic” innervation, which is carried to the nasal cavity via the greater superficial petrosal nerve. This nerve ultimately becomes the vidian nerve, which sends parasympathetic nerve fibers along with branches of the sphenopalatine nerve Blood flow to the nasal cavity and nasal mucosa is controlled largely by sympathetic innervation, fibers of which also travel along with the sphenopalatine nerve. Changes in sympathetic stimulation result in a rhythmic swelling of nasal blood vessels and a corresponding increase in nasal airway resistance (nasal cycle). The autonomic nerve systems can often be imbalanced during old age or due to allergies, inflammation, infection or medications. Normal nasal function can be disrupted, leading to nasal congestion and increased nasal secretions.

Read about using endoscopes to examine the nasal cavity and learn more about sinus anatomy . Issues Following Primary Rhinoplasty | Rawnsley Plastic Surgery Issues Following Primary Rhinoplasty Issues Following Primary Rhinoplasty Rhinoplasty is a complicated and delicate surgery with both aesthetic and functional aspects that take years of surgical experience to master. For this reason, regrettably, revision rates are very high. As a top specialist in the field, Dr. Rawnsley encounters a variety of problems that can result when rhinoplasty is performed by less experienced surgeons. Each problem requires its own specific corrective treatment. Some of the most common problems Dr. Rawnsley corrects include: Bridge and Central Nose Problems Polly Beak Deformity-Cartilaginous or Soft Tissue Revision Patient #1 In a natural-looking nose, there is a slight depression as the nose transitions from the bridge to the tip. In the case of the polly beak deformity, however, this bridge area above the tip is too high, giving the nose an appearance like a parrot's beak. Three different complications during rhinoplasty can lead to this problem, which is one of the most common seen after rhinoplasty surgery.

A cartilaginous polly beak deformity occurs when too much cartilage is left after surgery. Revision rhinoplasty in this case involves shaving down the extra cartilage. A soft tissue polly beak deformity occurs when a surgeon removes too much soft tissue on a patient with thick skin so the skin doesn't properly contract and flatten out, causing excessive scar tissue to form in the area. In this situation, corrective surgery involves removal of the scar tissue and the proper placement of an absorbable suture or skin tape to make sure the skin redrapes and heals appropriately. In the third type of polly beak deformity, the original surgeon fails to leave enough support for the tip of the nose and it droops over time, making the area above the tip appear to project too far. Revision rhinoplasty to address the problem requires the surgeon to reconstruct the nasal tip so it has adequate support. Profile Deformity: Persistent Bump or Scooped Out Bridge Revision Patient #3 Two post-operative profile deformities can result when a rhinoplasty attempts to address a bump (or bumps) in the nose.

In the situation of the "persistent bump," the surgeon fails to completely smooth all of the bone or cartilage of the nose. In the contrasting case of a "scooped out bridge," the surgeon misjudges and takes out too much bone, leaving the patient with an area that looks "scooped out" in his or her profile and too washed out from a front view. Revision rhinoplasty to address a persistent bump requires additional smoothing with a nasal rasp, a precise tool that allows for an extremely controlled removal of the problematic bone or cartilage. Correcting a scooped out bridge requires build up of the missing area with the patient's own cartilage. Collapsed Central Nose: Middle Vault / Inverted "V" Deformity and Internal Valve Collapse The "Middle Vault," also known as the "Inverted V Deformity," occurs when a bump is removed from the central nose, but inadequate support is provided. The center of the nose collapses, both inhibiting breathing and making the nasal bones visible to the naked eye in the shape of an inverted "V." Breathing will also be inhibited when the removal of a bump causes the collapse of the narrowest area inside the nose, the internal nasal valve.

As with a scooped out bridge, a revision rhinoplasty to address a collapsed central nose or internal valve collapse involves rebuilding the missing area with the patient's own cartilage. Irregular Bridge or a Poor Bridge to Tip Relationship Revision Patient #4 Other general aesthetic concerns relating to the bridge can occur after a rhinoplasty procedure. At times, the problem is simply that irregularities appear in how the bridge heals after the removal of a bump. In addition, there can be issues with the middle one third of the nose, called the central nose. The central nose forms the transition from the bridge to the tip and must be in proper proportion to seamlessly blend the two together in an aesthetically harmonious relationship. If any of the three parts are out of balance, the final result will be unsatisfactory. Deviated Nose Issues Revision Patient #7 A deviated nose is a nose with twist-either in the upper, middle, or tip of the nose. It is one of the most difficult problems to address through rhinoplasty and can persist after a original rhinoplasty or a revision rhinoplasty. It can even be introduced through a rhinoplasty or revision rhinoplasty procedure.

A frequent cause of a pre-existing deviation is crooked nasal bones. When the problem is introduced through surgery, it is sometimes because the efforts to remove a bump or other issue cause bones to shift. The techniques to address deviations vary widely depending on where the twist occurs and all the details are highly technical. If your problem involves a deviation in the nose, please discuss it with Dr. Rawnsley one-on-one, for an expert analysis of your particular situation and the best approach to address it. Tip Problems Pinnochio Deformity/Overprojected Tip One of the most common mistakes seen following rhinoplasty is the over-protected tip. Once a prominent bump is removed, patients often discover that the tip of the nose projects too far from the face. The problem can be exacerbated if the bridge of the nose slopes too much post-surgery. In many cases, surgeons simply do not dare tackle the issue of the over-protected tip during a rhinoplasty because the techniques to deproject the tip are highly technical and require advanced skill and a deep well of experience. The surgeon would rather avoid the procedure entirely than risk reducing the tip too much.

In addition, it is practically impossible to meaningfully reduce the tip in a standard "closed" rhinoplasty procedure. Only an "open" procedure, such as those performed by Dr. Rawnsley (where the flesh between the nostrils is cut), can effectively achieve true deprojection of the tip. The good news is that once a proper open procedure has been performed the structural support for the tip of the nose is far stronger than it would have been without revision rhinoplasty. Overly Shortened Nose/Over-Rotated Tip Overresection is the technical term applied when too much of the supporting structure for an area of the nose is removed during a rhinoplasty. The problem can lead to several tip-related abnormalities. If an overresection occurs in the front end of the septum (the structure dividing the two nasal cavities), the tip of the nose can fall backward, causing an overly shortened appearance where the tip is over-rotated upward, like a "pig's snout." Correcting this problem requires the restoration of proper supporting structures in the septum.

Droopy Tip/Under-Rotated or Poorly Supported Tip Conversely, overresection can also lead to the opposite problem where the tip of the nose droops, called a ptotic tip. In this situation, too much of the tip's support structure cartilage is removed and the end of the nose collapses downward. To lift the tip and correct the problem, the revision rhinoplasty surgeon must rebuild the weakened or missing underlying structure and thus restore support strength to the tip. Tip Bossae (Knuckling) If the two projecting points of cartilage that support the nose tip are too aggressively removed they will lose their springy structure and remaining cartilage will begin to bend and twist. This causes a problem called "bossae" or "knuckling" where the cartilage turns upon itself and the weakest points at the joints of the cartilage form very noticeable bumps or "knuckles." Attempting to trim these knuckles as some surgeons do will only further weaken the tip structure in the long term. Instead, the entire tip structure must be reconstructed so it has the strength to last the test of time.

Asymmetric Tip It is important to remember that whenever a rhinoplasty is performed, it involves two separate procedures, one to the right side of the nose and one to the left. In every stage of the surgery, great attention must be paid to symmetry. The cartilage on both sides of the nose tip must be removed to exactly the same degree or and asymmetric tip will result. Asymmetries may also occur due to unequal scarring during the healing process and not reveal themselves until months or even years after the fact. For a successful revision rhinoplasty, the surgeon must pay careful attention to symmetry at every stage of the procedure and through extensive experience anticipate how the scar tissue is likely to form and adjust accordingly for a final, aesthetically satisfying result. Pinched Tip Rhinoplasty procedures using open technique (where the flesh between the nostrils is cut) is an innovation of the last decade. Before that "reductive" rhinoplasty was performed with closed technique, a much simpler approach where cartilage and bone were quickly removed to narrow and shrink the nose, allowing the entire procedure to be completed in about half an hour.

Unfortunately, when this approach is used, over time the skin, the soft-tissue envelope, and areas of scar tissue around the nose invariably contract and can look distorted. One of the most common defects and a telltale sign of this style nose job is the "pinched tip," where too much tip cartilage was removed. Revision rhinoplasty to correct the problem involves the restoration of cartilage to restore proper fullness to the tip. Unitip Deformity A "unitip deformity" is the term given to the problem where the two points of cartilage (like two wings) that form the nose tip are pulled so close together it appears as if the nose comes to a single point. The problem usually occurs when a surgeon cinches down the suture between the tip points too tightly. To correct the problem, the points must be separated and rebuilt with cartilage to achieve the proper balance. Other Tip Problems: Wide Tip, Bulbous Tip, and Deviated Tip If too much of the supporting cartilage for the tip is removed, the resulting tip can collapse and wind up looking too wide or too bulbous. Excessive scar tissue formation after a rhinoplasty can also lead to these same two aesthetic problems.

Just as with a drooping tip, the underlying support for the wide or bulbous tip must be strengthened, while scar tissue needs to be carefully reshaped with sutures. A pre-existing deviated or twisted tip can persist after a rhinoplasty or it can result from a rhinoplasty when too much cartilage is removed on one side and the nose buckles and warps. In a best case scenario, the problem can be corrected by stabilizing or resuspending the tip cartilage with sutures. However, when the problem is the result of missing or damaged underlying structures from a previous rhinoplasty, grafts of cartilage from the septum or the ear must be used to rebuild the necessary support. Nostril Problems Collapsed Nostrils/External Valve Collapse The narrowest area in the inner structure of the nose is termed the "nasal valve." For normal, unobstructed breathing, it is essential that the entire valve area remain open. While internal nasal valve problems can occur during the removal of bumps on the bridge of the nose, external valve collapse happens when too much tip cartilage is removed during a rhinoplasty procedure.

Without proper tip cartilage support, a blockage occurs in the nasal valves just above the nostrils. Addressing the problem means reconstructing tip cartilage to provide adequate support. Hanging Columella, Retracted Nostril, or Alar Retraction Failure to ensure proper tip support can lead to other nostril-related problems. The "columella" is the name of the structure that separates the two nostrils. Ideally, this area should only be a few millimeters lower than the edge of the nostrils. If too much of the nasal spine or the bottom of the septum is removed (the structures that support the nasal tip), the columella will appear to hang down too much, called a "hanging columella," and the rim of the nostrils will retract, or pull back, excessively. Not only will the face take on an unflattering "snarl-like" appearance, but breathing can be adversely affected. Fixing the problem requires complex cartilage grafting. When too much cartilage is removed and excessive upward scarring occurs inside the nostril sidewall after surgery, patients can experience a different problem called alar retraction, where the inside nostril sidewall shows too much.

The problem can be corrected with cartilage grafts in minor cases or composite grafts of cartilage and skin (usually from the ear) in severe cases. General Aesthetic Problems Rhinoplasty - London ENT London ENT Rhinoplasty What is rhinoplasty? Otherwise known as a nose job, rhinoplasty is an operation performed with the aim of changing the shape of the nose. There are many different kinds of rhinoplasty depending on what needs to be corrected. These include nose straightening, making a nose larger or smaller, removing a bump from the nose or reshaping the tip of the nose. Occasionally it is necessary to remove or add pieces of cartilage or bone to change the nasal structure. Often it is the case that the central partition that separates the nose into right and left halves (the septum) is bent or deviated. In such circumstances, septal surgery (septoplasty) may be performed at the same time as the rhinoplasty in a combined operation called a septorhinoplasty.

A rhinoplasty can be a complex undertaking, as it is not just sufficient to correct the anatomical deformity but to ensure that the end result does not look artificial and closely matches the overall proportions of the face. It is often said that the best complement that someone can pay you following such an operation is not to be able to notice that you have had surgery at all, so natural should the nose look once healing has taken place. As a result it is important that you approach a surgeon with experience and expertise in this challenging but interesting field. Should I go for a rhinoplasty? If you are interested in improving the shape and features of the nose in order to change its cosmetic appearances, then rhinoplasty may be for you. If you are also having difficulty in breathing through the nose, this may be due to other structural abnormalities such as a septal deviation or nasal valve problems which can also be fixed at the same time as the nose job. You need to have a reasonably realistic idea as to what you would like your nose to look like. It is not possible to create any nose on any face, nor indeed sensible as there is a massive degree of variety in human appearances and not every nasal shape will suit every person.

There is no such thing as a ‘perfect nose’ but a pleasing nasal shape for a given individual depends on many factors including the bony contours, dimensions of the face, skin colour, skin thickness and race. People who believe that their lives will change if they have cosmetic surgery are often disappointed. The most common problems that people are concerned with include deviations of the nose to one side, a nasal hump, a ‘dip’ in the nasal profile, too wide or too a narrow nose, or problems with the soft nasal tip which can be over-protrusion, too broad or ill-defined a tip or irregularities. As there are so many factors involved in the decision regarding surgery and what can be achieved surgically, you are well advised to discuss your aims in detail with your specialist who will also undertake a thorough examination and appraisal of the realistic expectations. How successful is rhinoplasty surgery? The thickness of the skin is important in how much better the nose will look after a rhinoplasty. Imagine the skin of the nose is like a duvet on a bed. If the duvet is very thin then an object placed under the duvet may show through on the outside.

On the other hand, the very same object may not show through a much thicker duvet. So in the much the same way, if someone has thin skin, it makes it more difficult to camouflage bumps or dips in the nose. If the skin is thick, some of the subtle changes that can be made on the inside may not show up on the outside. Another factor is that if someone has had several nasal injuries or fractures to the nose, this may make it more difficult to render the external shape perfectly straight. Similarly, it is harder to predict the precise end result in people who have previously undergone rhinoplasty surgery owing to the presence of scar tissue. As mentioned before, your surgeon will aim to produce a nose that looks natural for you. However, it is rarely possible to say with certainty exactly how your nose will look after a rhinoplasty. It is important that you discuss your expectations with your surgeon. About 90-95 % of patients are happy with the results of their operation but some people request more surgery. You may change your mind about the operation at any time. Signing a consent form does not mean that you have to have the operation.

If you would like to have a second opinion about the treatment, you can ask your specialist or GP. Before rhinoplasty – what needs to be done? Photographs will be taken to allow a record to be kept in your notes of how your nose looked before surgery, and to allow the surgeon to plan your operation. You may also wish to see your specialist on more than one occasion before surgery to allow you sufficient opportunity to ask any questions you may have. It is important that you are not taking any herbal or other medications which might thin the blood in the two weeks prior to the operation, as this might increase the postoperative bruising around the nose and face. Rhinoplasty – types of operation Rhinoplasty surgery involves reduction, augmentation or refinement of the patient’s nose to give a balanced and proportioned nose. Reduction rhinoplasty involves the removal of a nasal hump along with re-breaking the nose to reduce any excessive width. The tip of the nose may be asymmetrical, over-protruberant, depressed or misshaped. If building up is required, this can be achieved using tissue obtained from another part of the patient’s body.

Most often cartilage is used and this can usually be conveniently sourced from the nearby nasal septum. Alternative sites which can be used include the ear or rib. Synthetic material are sometimes used, such as gortex or silastic but there is a greater risk of rejection or infection compared with the patient’s own cartilage. Rhinoplasty – the operation Rhinoplasty and septorhinoplasty are usually performed with you asleep under a general anaesthetic. The surgery can be approached either through the nostrils (intranasal) or by the use of a small incision on the under side of the tip of the nose (external). Whichever method is used, the skin of your nose is gently lifted off the underlying bone and cartilage. A hairline fracture may be made in the nasal bones to allow the surgeon to change the shape of the nose. Pieces of bone and cartilage can be removed from or added to the nose to smooth out any bumps or dips. One reason why an external approach may be chosen is that it gives better access to and exposure of the nasal tip in case any refinement is required here. If a septoplasty is being undertaken, this is usually performed at the beginning of the procedure.

Once the surgery is over, the cuts will be sutured with absorbable sutures. Packs and splints It may be necessary to put a dressing into each side of your nose to prevent early bleeding. These are sometimes called ‘packs’, and they will block your nose so that you will have to breathe through your mouth. These are usually quite light and are usually removed a few hours after the surgery, although on occasions they may need to stay in overnight. It is quite usual to get some bleeding when the packs come out – this will settle quickly. By the way, contrary to common perception, removing packs from the nose is not excruciating, unlike in the past when heavier duty packs were used. Your packs should come out quite easily with only a little discomfort. Sometimes a small piece of plastic may need to be put in your nose to prevent scar tissue from forming. These are called ‘splints’ and they will be removed after about a week. After rhinoplasty surgery: You can expect to go home on the day of the operation although on occasions an overnight stay may be required. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work, you should take two weeks off.

Ask your nurse if you need a sick note for your time in hospital. There will be a little bleeding from the nose for a few days after the operation. This may be blood or more commonly a mucous or clear discharge which is blood stained. This should not be particularly severe and should decrease in amount as time goes on. An increase in bleeding at a later date may indicate a postoperative infection and medical advice should be sought. The front of your nose is likely to be tender for a few weeks. The nose is likely to become a little blocked, particularly so if you have also had a septoplasty. In this case, the feeling of blockage gradually gets worse for the first 7 to 10 days and it will feel as though you have a heavy head cold for the first two weeks. The salt water solutions and drops/sprays will help keep it reasonably clear. You may be able to see some stitches inside the front of your nose – these will dissolve and fall out by themselves. If you had an external approach, you will have stitches in the skin of the front of the nose, which will need to be removed by your specialist approximately 5-7 days after the operation.

You may have some bruising and swelling around your nose and eyes for one to two weeks. Sleeping upright with extra pillows for a few days helps. The majority of the swelling subsides after two weeks but it may take longer before the skin and soft tissues over the bone and cartilage fully settle. Fine changes may continue to occur up to a year after the rhinoplasty at which time the final results of surgery may be judged. Following rhinoplasty or septorhinoplasty, the skin of the nose is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least six months. The nose may feel a little stiff and numb for up to three months, particularly around the tip. How long will I be off work after a rhinoplasty? You can expect to go home on the day of the operation although on occasions an overnight stay may be required. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work, you should take two weeks off. Ask your nurse if you need a sick note for your time in hospital.

Do’s and don’ts after a rhinoplasty Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. Your nose is likely to be tender for a few weeks so try not to get it knocked and be particularly careful around other people, especially young children. Sleeping upright with extra pillows for a few days helps to reduce the swelling and bruising around the nose and eyes. Try to stay away from dusty or smoky places. You should not play sports where there is a risk of your nose being knocked for about a month as it will feel quite tender. As the skin become quite sensitive and prone to the effects of ultraviolet radiation, it is important to wear strong sunscreen and a hat for at least six months. What can go wrong after a rhinoplasty? Rhinoplasty surgery is generally extremely safe, but there are some risks and complications that can occur as after any operation. Occasionally, the bleeding that you expect from your nose can be more severe than usual and it may be necessary to put additional packs into your nose or even to need another small operation under an anaesthetic to stop the bleeding.

This can happen within the first few hours after surgery or up to 10 days later. Infections of the nose are rare after this type of operation. You may suspect an infection if you notice a foul smelling discharge from the nose which may contain green pus, a high temperature, increasing headaches, new bleeding from the nose several days later or if your nose becomes more sore. If it happens you are advised to see a doctor as you will almost certainly require antibiotics. More rarely, if you have had a septoplasty, the operation can cause a hole in your septum going from one side of your nose to the other. You will more than likely be completely unaware that it is there as most of the time it causes no problems at all and needs no treatment. On occasions it can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Further surgery can be carried out if necessary to repair the hole. Very rarely, you can have some numbness of your teeth and/or upper lip. This usually settles with time. Common Conditions Treated What is the role of the nasal septum? « What is the role of the nasal septum?

Deviated nasal septum Many patients are somehow confused about what the septum is and what the role of it is in our nasal passages. Anatomically, the septum refers to the wall that separates the left and right sides of our nasal passages. There is mucous membrane lining over the entire septum on either side, and the center part is made from bone and cartilage. The role of the septum is essentially similar to lane markers in a busy highway. The septum allows the air that we breathe in through our nostrils to go directly from the tip of the nose into the back of the nose and into the lungs. Without the septum, the air that we breathe in might “get lost” in our nose; the turbulence might interfere with the direct transit of the air directly into the lungs. In an ideal situation, we would like the septum to be a straight wall that goes in an up and down direction. In reality, everybody has some degree of deviation of their septum. Sometimes this is due to the way that the nose develops and sometimes it could be due to a previous injury or fracture of the nose.

The degree of the deviation of the septum, as well as the anatomy of the side wall of the nose, can result in various degrees of blockage of the nasal passages as well as the sinus drainage pathways. In general, part of capacity to breathe adequately through the nasal passaged is dictated by the general health of the membranes, and other part is dictated by the anatomy of the septum. A patient with a deviated nasal septum is considered to have a fixed anatomical abnormality that will not respond to any kind of medical therapy for an anatomical blockage. As such, the only remedy is to undergo corrective surgery. Correction of a deviated septum surgically is usually called septoplasty. In most cases, this procedure is done in the operating room under anesthesia. Through a small incision into the membranes at the level of the nostrils, the bone and the cartilage of the septum is exposed. The portion of the septum that is not straight can then be either shaved or realigned internally. The septoplasty procedure alone usually does not result in black and blues under the eyes or any change to the external appearance of the nose.

Most patients are able to go home the same day, and should be able to return to most normal physical activities within the few days. It is usually not easy to determine if the patient is suffering from a deviation of septum versus other reasons for nasal obstruction by external examination. Examination of the inside of the nasal passages can be done with the help of nasal endoscopy. This is the best determinant to ascertain deviation of the nasal septum. Once the diagnosis is confirmed, a decision to go ahead with the septoplasty procedure is made by the patient given the degree of blockage that they experience. Tags: deviated septum , ear nose throat , ENT , Isaac Namdar , Isaac Namdar MD , nasal blockage , nasal obstruction , New York , new york city , Otolaryngology , Otorhinolaryngology , septoplasty , septum , turbinate , turbinate hypertrophy This entry was posted on Thursday, June 7th, 2012 at 4:53 pm and is filed under Nose . You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response , or trackback from your own site. Leave a Reply

Question: What name is given to the bone and cartilage partition that separates right and left nostrils?
Answer: SEPTUM